Is California Gov. Gavin Newsom exaggerating when he says Golden State residents now will have “universal access to health coverage” as a result of a budget deal that will open Medi-Cal to 700,000 undocumented immigrants ages 26 to 49?
The governor’s boast is accurate, according to health policy experts, although it falls short of his 2018 campaign promise to implement a government-run, single payer health care system for Californians.
Nonetheless, experts said the latest Medi-Cal expansion represents a “a big, bold step” that ensures anyone in the state will be able to sign up for a medical plan when this last remaining group of undocumented immigrants gets Medi-Cal access in January 2024.
That’s important, they say, because people tend to avoid accessing medical care if they don’t have insurance and believe they can’t afford a doctor’s visit.
Researcher Shana Charles of California State University, Fullerton has studied health care access for 20 years, and year after year, she said, studies have shown that health insurance is the determining factor when it comes to whether US residents can get medical treatment.
That represents a change in thinking among health care advocates, who once believed that government-subsidized or privately run urgent-care clinics could meet the needs of uninsured people, she said. Instead, researchers found uninsured people tend to delay care until they feel they are at death’s door, and then would go to hospital emergency rooms.
“There might be some minor differences between how easy it was to access care if you were on Medi-Cal or if you’re on job-based coverage,” Charles said, “and yes, those make a difference, and we want to make Medi-Cal as good as possible, but the biggest barrier by far was just not having coverage at all.”
The new expansion makes 700,000 adult undocumented immigrants under age 50 eligible for Medi-Cal, the state’s income-based health care insurance, at a cost to taxpayers of about $2.6 billion a year.
It follows a decade of efforts by Democratic leaders to make more Californians eligible for health insurance, beginning with the state’s embrace of the Affordable Care Act in 2012.
California’s implementation of that law, known as Obamacare, led to some 5 million additional enrollees in Medi-Cal.
In 2019, California extended Medi-Cal to undocumented people under age 26. Last year, Newsom signed a law granting Medi-Cal access to 235,000 undodumented people over age 50.
The latest step makes Medi-Cal available to all other undocumented adults.
Charles of CSU Fullerton said she believes the overall percentage of the insured will soar to 96% or better in the next few years, up from 92.3% in 2020. By contrast, about 91% of all Americans have health insurance, according to the U.S. Census.
Single-pay health care bill
Newsom while running for governor in 2017 told reporters he’d go even further when he endorsed single-payer health care, which would replace private-sector medical insurance plans with a government-run system.
“You have my firm and absolute commitment, as your next governor, that I will lead the effort to get it done,” Newsom said at the time. “We will get universal health care in the state of California. We will make sure it happens.”
Since then, he’s taken a more blended approach by signing bills to expand access to insurance plans.
Two unions representing more than 175,000 registered nurses nationwide said their members are so concerned about challenges related to enrollment and access to some medical services that they will continue to push for a single-payer health care financing system where everyone is automatically enrolled and has equal access to care.
“The governor’s expansion of Medi-Cal for undocumented people is an absolutely crucial step in the right direction, but it maintains a fragmented, profit-driven system of private insurance with highly unequal tiers of care,” said Phillip Kim, a campaigns organizer for National Nurses United and the California Nurses Association. “This action does nothing to address the more than 12 million Californians who are underinsured and can’t afford to use their health care because of expensive deductibles, copays, and coinsurance.”
The unions supported a bill in the Assembly earlier this year that would have created a government-run, single payer system for Californians. Newsom did not weigh in on the bill, which divided Democrats in part because of its high cost and potential to increase taxes.
The bill’s author, Ash Kalra, D-San Jose, pulled the measure because it didn’t have enough support to pass. He has said he’d consider bringing it back in the future.
What’s next for California health insurance?
Dr. Sandra Hernández, chief executive officer of the California Health Care Foundation, said now that everyone has a path to get care through the state’s latest Medi-Cal expansion, policymakers must focus their efforts on removing bottlenecks to enrollment, specialty medical care and psychiatric treatment.
She said policymakers must educate people on the value of insurance, reach out to them to get them to sign up and expand the ranks of medical and behavioral health professionals needed to serve the growing number of covered patients.
“We do want people to have regular access to doctors so that they can get preventive services and stave off hopefully serious illness,” said Shannon McConville, a research fellow at the Public Policy Institute of California. “Then if you do have serious illness, it probably will take a while to find a specialist and do all that, but you should be able to find that care and have it be paid for. If you are uninsured, the chances of you being able to do that are even slimmer.”
While the expansion of Medi-Cal to undocumented immigrants and the growth of subsidized insurance for U.S. citizens certainly helps individuals and families, Hernández said, the effects of this this change extend far beyond those households.
Hospitals are much less likely to face unpaid bills, improving their financial stability, she said, and when the nation experiences the next pandemic, public health agencies will be able to more efficiently reach all California residents by going through their provider network.
And, many more Californians can get access care well before an emergency.
“Before we did any of this expansion, people who are uninsured would come to an emergency room because they didn’t have a primary care provider and they didn’t have insurance,” Hernández said. “They would come in with late-stage diseases, or they would go there because they’re working two jobs and their toothache or their ear ache … did not get managed in a primary care setting in a preventive way.”